In Spain, the number of diabetics is expected to exceed 3 million in the coming years. Currently, 6% of the Spanish population has diabetes. But did you know that by taking care of the health of your mouth, you can improve your diabetes control?
If you have diabetes, you should take special care with your oral health, since it has been scientifically proven that diabetics are four times more likely to suffer from gum infections. In fact, it is considered that ‘periodontal disease is the sixth complication of this disease’.
What are the oral health problems caused by diabetes?
On the one hand, diabetes mellitus is the most common endocrine disease and includes a group of metabolic disorders characterized by elevated blood glucose levels accompanied by long-term complications.
On the other hand, periodontitis consists of a chronic infection produced by mainly gram-negative anaerobic bacteria that colonize the gingival sulcus of the gingiva and attach themselves to the teeth. For a bacterial species to be considered a periodontal pathogen, it must have two main capabilities: firstly, it must be able to colonize the subgingival area (get under the gum) and, secondly, it must produce factors that either directly damage the host tissues or induce the destruction of these tissues.
In other words, periodontitis affects the supporting tissues of the teeth causing loss of insertion due to the destruction of the connective tissue that forms the gum and resorption of the alveolar bone, but it also entails a series of changes at a systemic level on the immunocompetent cells and cells that participate in the inflammatory response.
As we have said, numerous epidemiological studies have found a high prevalence of periodontitis in diabetic patients compared to healthy controls. In fact, many of these scientific studies have shown that there is a bidirectional relationship between these two diseases.
How does diabetes affect periodontitis?
Diabetes disease can alter the inflammatory response to microorganisms in the gingiva, as well as the ability to resolve the inflammation and subsequent repair of the supporting tissues of the tooth (bone and gingiva), which accelerates their destruction, causing tooth loss.
As we have already mentioned, diabetics are four times more likely to suffer from gum disease, a disease that, if poorly controlled, leads to its progression, causing serious cases. In fact, the response to this disease is even worse in patients with poor glycemic control who are users of dental implants, as they may also suffer from a disease known as peri-implantitis, which causes the loss of the implant.
How does periodontitis affect diabetes?
As we say, periodontitis is a consequence of infection and inflammation caused by the accumulation of bacteria and alters the inflammatory response that can spread throughout the body. An inflammation, that may be associated with the development of insulin resistance, increases the risk of diabetes.
In other words, the more severe the periodontitis, the greater the risk of suffering from diabetes and having serious complications derived from this disease.
On the other hand, it should be taken into account that other widespread factors such as a sedentary lifestyle (lack of physical activity), inadequate diet, overweight or obesity can also cause diabetes.
In summary, on the one hand, patients with diabetes (along with patients who smoke) have a higher risk of suffering periodontal disease. But, on the other hand, periodontitis can also affect diabetes, increasing the blood glucose level. Therefore, due to this bidirectional relationship between periodontitis and diabetes, it is very important that we take care of our gums, teeth and oral health in general to prevent periodontal disease.
Why control periodontitis in diabetics?
Well-controlled diabetic patients, evaluated according to their glycosylated haemoglobin levels in the blood, present less severity of periodontitis compared to poorly controlled patients. In other words, the control of the infection caused by periodontitis should be considered as part of the medical follow-up of diabetics.
Recently, a report published by SEPA (Spanish Society of Periodontics) and the SED Foundation, Spanish Diabetes Society, on Diabetes and periodontal diseases has revealed that dental visits represent a unique opportunity to combat diabetes, as they would help to identify these patients (many of whom are unaware of their condition) at an early stage.
The following is a list of useful tips for patients with diabetes:
- Perform periodic oral check-ups.
- To know and control the hygiene measures that can prevent periodontal problems.
- Avoid stress during treatment. It is advised to be performed in the morning (one hour after breakfast and insulin injection).
- Be well hydrated at the treatment and have a sugary drink available in case it is necessary.
- Remember that acute infections require immediate intervention.
- If diabetes is under control, surgical interventions can be performed. If it is not, non-surgical treatments are used until it is.
In short, and as we have already mentioned, diabetics should pay special attention to the state of health of their teeth and gums. If you have any doubts or problems, it is always best to consult your dentist.